The Snake Oil Medicine Show

There’s nothing earth-shaking in the world of massage politics on my radar this week, so I’m just going to make a few observations. I know that I am about to step on more than a few toes here, but it must be said.

I’ve got a few thousand massage therapists in my social networks (FB, LinkedIn, Twitter, Google +). In the mornings, when I’m drinking my coffee, I visit those sites and scroll through to see what people are up to. I like to read that people are having success with their clients, enjoying their work, being active in their communities, growing their businesses, volunteering, and a lot of wonderful things that massage therapists do.

What I don’t like to see is what I call the Snake Oil Medicine Show. There’s a popular band here in NC by that name, so I’m stealing it for this blog. According to Wikipedia: The phrase snake oil is a derogatory term used to describe quackery, the promotion of fraudulent or unproven medical practices. The expression is also applied metaphorically to any product with questionable and/or unverifiable quality or benefit. By extension, the term “snake oil salesman” may be applied to someone who sells fraudulent goods, or who is a fraud himself.

There are a lot of products (and practices) out there that have no proven benefits at all, and many that have in fact been proven not to have any benefits. Massage therapists seem to be particularly gullible to falling into the trap of not only using them personally, but also promoting them and selling them to their clients. I don’t know the real reason behind this phenomenon, but I can guess at several: 1) The therapist is not interested in scientific evidence and buys into the hype on the product’s website. 2) The therapist is desperately looking for something to bring in additional income. 3) The therapist has a genuine desire to help people, and truly believes the wild claims made by whatever company is selling the product, and thinks that it’s a duty to share it with clients.

If you’ve been following me for any length of time, you know that I am interested in the evidence-informed practice of massage, and that I’ve been on a mission to bust the myths of massage. This problem goes beyond that; and if I tried to bust every unscrupulous product out there, I’d never have the time to write about anything else. There are a lot of “quackery” websites on the Internet that have done most of the work for me….if only people would read and believe. But the fact is, you can hit some people over the head with scientific evidence, and they’re not going to believe it. They’re too attached to that “detox” machine, or that dietary supplement, or that special water or whatever it is that they’re selling. Paul Ingraham, one of my favorite writers on the Internet, has written about a lot of these things (see www.saveyourself.ca) Dr. Stephen Barrett has had his Quackwatch site up for years (www.quackwatch.org). Another favorite of mine is a water myth website, found at www.chem1.com/CQ/

I’m not a scientist, or a very technical-minded person. Fortunately, I have some friends and acquaintances who are. I have often asked them “Can you explain to me how ____ works?” The usual answer to this question is “It doesn’t.”

As I said at the beginning, I’m about to step on some toes here, but then again, I do that on a regular basis, so what the heck. Here are the facts on detox foot baths, and may I say, yes, I have in fact used one myself in years gone by:

There is no way an electric current passing through a part of your body can distinguish between “good” molecules and “bad” molecules (“toxins”), most of which are electrically neutral anyway.

The skin is impermeable to all but a few chemical substances; there is no evidence that any that are found inside the body can pass through the skin to the outside, with or without the help of an electric current.

All but a very few of the “toxins” produced as metabolic products are colorless— suggesting that what you see during these “treatments” is put there for show.

You can in fact put a zucchini, or nothing at all, in the foot bath, and the water will still turn color. I have personally witnessed this happening. Then we’ve got the “alkaline water” products, including a well-known MLM company that sells filters for about $4000 bucks. That’s a European vacation, folks. Not only that, but the actual components of that water filter can be purchased at any home improvement or hardware store for about $35. Here are the straight facts on that, and YES, THIS IS WRITTEN BY A CHEMIST:

“Ionized water” is nothing more than sales fiction; the term is meaningless to chemists.

Pure water (that is, water containing no dissolved ions) is too unconductive to undergo signficant electrolysis by “water ionizer” devices.Pure water can never be alkaline or acidic, nor can it be made so by electrolysis. Alkaline water must contain metallic ions of some kind — most commonly, sodium, calcium or magnesium.

The idea that one must consume alkaline water to neutralize the effects of acidic foods is ridiculous; we get rid of excess acid by exhaling carbon dioxide.

If you do drink alkaline water, its alkalinity is quickly removed by the highly acidic gastric fluid in the stomach.

Uptake of water occurs mainly in the intestine, not in the stomach. But when stomach contents enter the intestine, they are neutralized and made alkaline by the pancreatic secretions — so all the water you drink eventually becomes alkaline anyway.

The claims about the health benefits of drinking alkaline water are not supported by credible scientific evidence.

“Ionized”/alkaline water is falsely claimed to be an anti-oxidant. It is actually an oxidizing agent, as can be seen by its ability to decolorize iodine (see video).

There is nothing wrong with drinking slightly acidic waters such as rainwater. “Body pH” is a meaningless concept; different parts of the body (and even of individual cells) can have widely different pH values. The pH of drinking water has zero effect on that of the blood or of the body’s cells.

If you really want to de-acidify your stomach (at the possible cost of interfering with protein digestion), why spend hundreds of dollars for an electrolysis device when you can take calcium-magnesium pills, Alka-Seltzer or Milk of Magnesia?

Electrolysis devices are generally worthless for treating water for health enhancement, removal of common impurities, disinfection, and scale control. Claims that “ionized” waters are antioxidants are untrue; hypochlorites (present in most such waters) are in fact oxidizing agents.

Claims that “water ionizers are approved for use in Japanese hospitals” are misleading: these “approvals” merely attest to the machines’ safety — that they will not electrocute you! My understanding is that the Japanese Health Ministry is highly critical of therapeutic claims made for alkaline water.

And yes, I have also drank alkaline water…several clients and a part-time staff member insisted on my trying it, and I did, but I can’t say it did anything for me that regular water wouldn’t have done.

What about the Chi machine? Actually, I used to house sit for a friend who had a Chi machine, and I would lie down in the floor and use it every time I was at her house. I personally found it very relaxing, and it felt good. In fact I would usually zone out and have a little nap while the machine was running. However, the big claim made about it is that it “maximizes the body’s natural absorption of oxygen.” Really? It’s shaking your ankles back and forth. How is that doing anything to maximize the absorption of oxygen? Can’t I just lie down and shake my own ankles and do the same thing without spending that $399? The websites touting the Chi machine go on about how cancer can’t survive when you’re fully oxygenated, disease can’t get you, parasites will disappear, and all illness will leave your body if you just have enough oxygen. The way I see it, I’m breathing, so I must have enough oxygen. How much more do I need? Am I going to breathe MORE if I shake my ankles every day? I don’t think so.

Shall I go on? There are so many dubious products out there, I could stop writing about the politics of massage altogether and have enough fodder to go on for years, but I’m going to stop here, for now. I’m sure those of you who sell the heck out of these machines will write in and tell me what a moron I am. Maybe ONE of you will perform a thorough scientific examination of the facts and decide that you’ve been hoodwinked into spending a few hundred, or a few thousand, dollars on something that doesn’t work, and you’ll quit trying to sell it to your clients. That would be nice.

31 thoughts on “The Snake Oil Medicine Show”

Until we mandate research (not just teach research literacy) as part of a condition for entry into the profession, then we cannot expect our therapists to have a value for it. The 3 reasons you gave for the practice of hocking the snake oil ALL lead back to this 1 fact. We need to start publishing or our profession will be perishing…

Thank you, Laura, for writing this! I can’t believe how many of my fellow massage therapists believe in such quackery. Scientific evidence must be taken into consideration, regardless of how we “feel” something is working. For example, Homopathic medicine, Crystals and Aura-reading has been de-bunked, but people really want to believe in them. James Randi has videos on YouTube about this. He also has a 1 Million Dollar Challenge for anyone claiming to have psychic, supernatural or paranormal abilities. Here’s the chance for all the quacks to prove themselves; http://www.randi.org/site/index.php/1m-challenge/challenge-application.html
Here is a video of James Randi taking a whole bottle of Homeopathic sleeping pills… because they don’t work; http://www.youtube.com/watch?v=sCYvOgBaEY8

“The idea that one must consume alkaline water to neutralize the effects of acidic foods is ridiculous; we get rid of excess acid by exhaling carbon dioxide.”

That’s correct, and in addition, the gastric juices in the stomach are fairly close to pure hydrochloric acid. The acidity or alkalinity of any particular food you eat are like an ice cube when compared to the ocean of acidity in your stomach and what leaves it to go to the small intestine.

I wish we had time to properly teach anatomy, physiology, and pathology in massage school. When I taught it, I had four hours per week for an academic year to teach all three subjects at once–it’s just not enough, in the face of the complexity of any of the subjects, let alone all three.

A good part of the reason the whole oxygenated BS is perpetuated is the misunderstanding of the work of German biochemist Otto Warburg. In 1931 he won the Nobel Prize for his research showing that cancer thrives in conditions that are acidic or anaerobic (without oxygen). Many of the “snake oil” companies pass that info and skew it to sound like he discovered that oxygen kills cancer, which isn’t what his research was about.

I know that people do tire of articles such as these and also feel that they and their beliefs are being attacked, but this is the type of stuff that will help create the shift in our field to the importance of critical thinking. I agree with Holly Foster who wrote of the importance of creating a mandatory course in massage school that covers research.

I agree, Laura, that M.T.s seem to be especially gullible when it comes to these things. I’m also with you about the relaxing effects of the chi machine. I have found them for 5 bucks at Goodwill, and for that it’s a nice little doo-dad to relax with, but I don’t think it will cure cancer!!

Right on Laura!
Toxins are one of my many snake oil hot buttons…. “removes toxins”….what toxins, how and where is the peer reviewed journal? Where is the data? The lactic acid myth was debunked many years ago, yet many still preach it.
As far as the “Biomat” footbath that removes toxins, you will find them in aisle 1, next to the Chi machines and negative ion generators.

As Fleetwood Mac sang, “Don’t stop believing”. Belief will always exist independent of reality or anything resembling critical investigation. You can’t stop it with exposure or study. But, one MT at a time, we can inspire. And you are doing a good job at that. Thanks Laura.

Not just a course to cover research. Research literacy is just a small part of the problem.

We’ve all read research studies (that’s an assumption on my part and I apologize if I’m incorrect). It seems that when something goes on paper (or in digital format), it then becomes the gospel — at least until something else comes out. I want my students to be inquisitive.

If you read something, it seems to jibe with your current paradigm, then it becomes your truth. Just as we accepted our massage instructors statements of “massage improves circulation; therefore, it removes toxins from the body.” Which we now know it false. I want my students to question their profession. Not in a “why am I doing this” sort of way, but a “what happens when I do this” sort of way.

We need to expand the general curriculum of therapeutic massage to include CONDUCTING research. My students come out of the program knowing how to read a research abstract. But, I cannot instill in them the true concept of what goes into conducting a research study in a 660-hour program. There’s simply not enough time.

In my area people are having “wrap parties.” Much like a Mary Kay make-up party, people gather to test a product, look through a catalog, and spend $ on weight loss and energy products. These wraps advertise losing inches instantly. The website itself doesn’t say how it works, just that inches disappear for 72 hours, and you must use another wrap to keep the inches off. However, the people (not massage therapists) are telling everyone that the wraps break down fat cells, put them into the blood stream and you drink water to pee them out. No lie. I want to SCREAM! And people spend money on this! I looked at the website to see if the company was telling people that, but it doesn’t. It is the people selling it and having the parties. It is extremely frustrating!

I’ve had body wraps, and I’ve performed body wraps. My former boss used to own one of those Suddenly Slender franchises. I have always told anyone getting one that it causes a TEMPORARY loss of water weight–temporary as in 24 hours–and that it is NOT a weight loss solution. Getting one might allow you to squeeze into a dress that’s a size too small–if you don’t eat anything while you’re wearing it. Years ago a lady had me wrap her three times in one day so she could fit into her wedding dress that night.

Yes, I tell people it’s water weight if they ask me. Although, these aren’t the whole body wraps like in a spa. They are patches. They wrap around the waist or leg or arm. I thought they were going to be the spa treatment-type wraps, but they aren’t. I don’t mind what the company says, because they aren’t promising permanent results, it is the people that are ASSUMING what the product is doing. Frustrating.

Thanks Laura,
There are some really interesting points and a few things come to mind.
Regarding research – this is a great way to validate the use of any method, but there are two things that I am reminded of from my research methods days in undergrad. First, we don’t know all of the mechanisms at work even though there may be good research design. Research is based on fundamental principles that are already known yet are influenced by things we are not yet aware of. That is not to say research isn’t reliable but it is inherently flawed.

The second, is the lack of research on the Placebo Effect and this brings up back to the limited knowledge we have.

As far as MLMs etc. I just wrote a post about the ‘retail’ side of things and have been seeing this trend of massage therapists moving into selling supplements, oils etc. The oils I can see but the supplements are a little dicey – since we are not trained in nutrition or biochemistry.

Which brings us to the part about therapists. I was one of those therapist who fell into the MLM trap. But I think more for the experience factor… In participating a few short months I saw the hungry eyes and slippery slope in the networking meetings. It was kind of like ending up in a single’s bar thinking your going to a family restaurant. Creepy.

Here is the thing I see with massage therapists… the lack of understanding in principles of marketing, business, and the ethical considerations for a health care practitioner engaging in such things makes them vulnerable. You may see this in a different light since you have written a few books/articles about it. It is familiar to you. I don’t think the line is always clear for most therapists. Maybe a therapists does have a vague sense, but it fades because it’s not reinforced enough in our profession.

I for one wish I had read your material for my business class when I was training. I wish in my training nine years ago that I would have also been exposed to the Legislative class I developed last year to help me understand the considerations I would be facing when practicing as a ‘real’ therapist. We have a ways to go in educating therapists.

Product developers see massage therapists as a ‘ripe’ market/distribution chain. The tactics they use to convince therapists are designed to be manipulative although cloaked as persuasion. For therapist who are hungry to earn a living and are without good ethically effective marketing skills they are easy to manipulate and exploit. I got hoodwinked and I consider myself to be pretty good at discerning.

Where is the solution? It starts with training and with practicing massage therapists setting proper examples of good practice standards and with efforts like yours!!

I think Tracy is on to something. The focus of this profession in the last couple years has been on facts and research. The problem is … people don’t make decisions based on facts or research. If they did, tobacco smoking would be eradicated by now. They make decisions emotionally and out of habit. One can lay down all the facts, but to engage someone and to guide their behavior is a whole other thing.

Along with the facts and research, personalities entered the mix. Many have turned to skeptics for answers and guidance. This comes with its own set of problems. Some skeptics come with the attitude “we have charts and facts to back us up, so F$%* OFF” which is a big turnoff for most people.

Also, skeptics’ assertions need to be examined as much as any other hypothesis because they may have their own reasoning flaws. Laura mentioned Ingraham, who I agree is a good writer. Take his most recent article that is titled “Poisoned by massage” (http://saveyourself.ca/articles/poisoned-by-massage.php) as an example. The article sets a hypothesis that massage causes Rhabdomyolysis, which would very well be the case, but presents no evidence other a reported case of an 88-year old receiving an intense “massage” by two “massagists” at once (http://ndt.oxfordjournals.org/content/21/1/233.full.pdf+html) and which supposedly caused Rhabdomyolysis. I am saying “supposedly” because there could be other unexplored reasons that the 88-year old developed Rhabdo, such as his fall to the ground. So, how does Ingraham reach his conclusion? He states “I think the evidence and reasoning is good, and I have high confidence that massage actually does “poison” us a little.” I have a hunch he may be right for some types of intense massage, but the approach is hardly scientific.

We have gone from the point of not using research enough to citing science gurus, and studies, and PubMed so frequently, and for such diverging purposes, that people are reaching state of overload and becoming numb.

While research and being evidence-based/informed was intended to help us serve the clients better, it has become the end instead of the means to the end.

So, what does one do? Just like Tracy said, I think massage education needs to focus on professional development and ethical business conduct. Laura, I know you have been doing this in your books, but I don’t know that everyone gets it.

What I am suggesting does not mean that we stop teaching research literacy. It means moving away from the “hit them over the head if they say toxins” approach to “what true professional would ever say things they cannot explain?” approach. The former is a research-centric approach, the latter a client-centric approach.

We need to make the client the end, not the research or acceptance by the medical community. A therapist would stop selling those devices not because of fear that they will be chastised but because it would be irresponsible to the client. It’s a subtle difference, it’s a matter of focus.

Laura… I love your bravery. In massage school I was intrigued by notions of energy “healings” and auras, but my brain kept saying “error, does not compute”. I asked around about classes in Rieki and other healing energy classes, and when I had the chance to read what was actually going on…. these ancient arts were manipulated and distorted by hand-me-down information and secrets and levels and who exactly was a “master” was also a toss-up. I’d rather follow documented research and come to conclusions based on fact. I do believe there is energy release and energy given during massage, but there is no way to document or to say what exactly is happening in these moments. Sometimes you just have to accept that there are unknowns. And intuition can be a powerful tool in the massage therapist kit. But to sell yourself as a “master” at something is really against my beliefs. If you are really healing someone, from the result of a higher power (I call him, God), that gift is a gift, meant to be given as a gift. And no one OWNS the right to be a “master” at that. Now if you are trained in massage, anatomy/physiology, ethics, business, etc. you have actually learned skills that are documented to produce results. That’s a career. You own/earned that right to make money doing what you were taught.
I’m in agreement… too much snake oil. Or “hoo doo voo doo” as I call it. LOL! Good for you for taking a stand Laura! 🙂

Laura,
I love your frank and honest retort and also believe in the scientific method and the common sense of massage practice. I especially liked your YOUtube Toxin speech, thank you!

Although I have always been skeptical of Snake oil type products with outrageous claims (the water thing and Chi machine) I am sticking my neck out here… I do see a place for a retail side in my practice.

As Tracy has elaborated on the lack of understanding and training -“the lack of understanding in principles of marketing, business, and the ethical considerations for a health care practitioner engaging in such things makes them vulnerable.” This is so true and if the company you are representing does not have good compliance training with ethical and scientific support on their website, then you are vulnerable, you are misleading people. I am clear that I am not a nutritionist and only give information that guide people to their own decision. Also I think -does the guy at Whole Foods have more cred and training than me? These are the people giving the majority of people advice about supplements-not nutritionists! There is more crap out there than not, especially in the drugstores when it comes to supplements. I look at is as a service to let my clients know about the highest quality proven products. Unfortunately not all direct sales companies are the same.

I think if you do have products for sale- do your homework and choose a company that has the actual science to back it up (double blind placebo studies, multiple times) and compliance education to be safe. There definitely needs to be a high standard and excellent training. You have given many examples of how it can go wrong, does that mean it is all wrong or do we need more ethical, marketing and business training? The reason people are attracted to the retail is the residual or extra income. Until most LMT’s can make it without burning out it will still be attractive. Be smart, do your homework! Be professional.

In NY state where I practice, we are licensed health care professionals and all of these professions share a regulation: § 29.1 (b) (2) unprofessional conduct that states

“2.exercising undue influence on the patient or client, including the promotion of the sale of services, goods, appliances or drugs in such manner as to exploit the patient or client for the financial gain of the practitioner or of a third party.”

The ethical line being drawn here I think is asking several questions (this will be part of an upcoming post at mtpnet) that we as trusted health and care providers need to consider:

1. Does the client safely benefit from this product?
2. Is the product facilitating results within the scope of your practice?
3. Does the action of the client gain you (or a third party) a profit, or financial benefit of any kind?

Business practices are essential for solo therapists but… the lure proposed by MLM’s under which many ‘snake oils’ are delivered is its a win/win situation. MIND you, they MLM’s are using marketing tactics that have one goal – to get people on board selling their product. They are in the retail model… selling product will make them money.

This is slippery for massage therapists and with the estimated 300K of us, you can bet we are one of their target markets.

My point is that there is an ethical line when it comes to selling anything other than what we are licensed and is within our scope to do.

Spas, for instance expect therapists to Upsell. Having worked in spas and having been ‘reprimanded’ for not selling enough, this is definitely where the health practitioner and spas business model conflict.

Some Spas, dare I say all MLMs send a confusing message to therapists who lack the breadth of knowledge that would help them to properly discern. (at least in NYS)

I agree with Tracy Bell that there is a conflict between the codified MT practitioner ethics and the pressure of the spas and establishments to upsell and to perform services of questionable value and in some cases, particularly clients with certain chronic illnesses, danger.

I am a massage instructor in a Junior College-based program. I teach the sciences: Kinesiology, Anatomy and Physiology and Pathology. I am a retired nurse and I am, in addition to my RN, LMT and LMTI, degreed. So much of this, as you call it, snake oil fraud could be prevented with more science being taught to student therapists. Ours get nowhere near enough hours in any of the sciences, particularly Pathology, which to me is a vitally important issue. There are many disease processes for which massage is absolutely contraindicated because of danger to the client, and too many massage establishments who do not give therapists the discretion to say “no,” except at the cost of their job. And then someone else would perform the massage anyway. I don’t know what the answer is. I have been trying to figure that out for years. There needs to be more reputable and controlled research . . . preaching to the choir here. Maybe the profession needs to develop a group of scientific “debuggers?’

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